Difficult Airway Management Research Articles

Difficult Airway ManagementA Challenge to Anaesthesiologists

Anticipated and unanticipated difficult airway remains an everlasting challenge for anesthesiologist. Most airway problems can be solved with enough resources available but clinical judgment borne of experience, and expertise is crucial in implementing the skills in any difficult airway scenario. Detailed patient history, best utilisation patient protocols, with good clinical assessment may reduce the difficult airway complications. The present series reports six patients with anticipated difficult airway-burn contracture, fractured mandible with restricted mouth opening: meningo myelocoele (in a neonate, and there was difficulty in positioning for intubation), anterior mediastinal mass (with difficulty in maintenance of anesthesia), cervical spine injury and one patient with left mandible fracture with history of road traffic accident. Different methods were successfully adopted for managing all of these difficult airway cases. Hence planning, preparation, and execution is very important in successful management of difficult airway.

Contrived Breathing Circuit Connection for Emergency Percutaneous Transtracheal Ventilation by Needle Cricothyrotomy in the Field.

Surgical airway approaches are, at times, last resort options in difficult airway management. In Special Operations these interventions confront distorted anatomy from combat trauma, extreme conditions, and may be performed by non-medically trained personnel. Under these circumstances, needle cricothyroidotomy using a large bore intravenous catheter can be considered. A small syringe connected to the needle can confirm transtracheal placement through air aspiration before passing the angiocatheter over the needle. Button activated retracting needles should be avoided for this when possible. We recommend a 3-mL Luer-lock syringe because a small syringe is better suited for generating pressure and once the catheter is in the trachea, this same syringe can be connected to bag valve ventilation by replacing its plunger with a connector from a 6.5-, 7-, or 7.5-mm endotracheal tube. Adding these small and light high-yield items to the Tactical Combat Casualty Care medic inventory should be considered in future revisions.

Role of conferences and continuing medical education (CME) in post-graduate anaesthesia education.

Role of conferences and continuing medical education (CME) in post-graduate anaesthesia education.

High flow nasal cannula (HFNC) and video laryngoscope (VL) as essential adjuncts in management of obstetric difficult airway: Efficacious tools or simply an industry push!

High flow nasal cannula (HFNC) and video laryngoscope (VL) as essential adjuncts in management of obstetric difficult airway: Efficacious tools or simply an industry push!

Airway consideration in cleft patients-challenges and approaches

Over the last few decades, there is a paramount shift in the implementation of pediatric anesthesia. Although for most of the time, difficult airway scenarios are well-planned and executed, occasionally an unanticipated difficult situation may still arise. This is more common in patients with orofacial anomalies such as cleft lip and palate which constitute one of the most common craniofacial anomalies. Various approaches to difficult airway management in an infant undergoing cleft repair have been described in the literature. However, no approach is considered ideal. It depends on age, associated anomalies, at hand resources, and the skill of the anesthesiologist. The unique anatomical and physiological features of pediatric airways impose additional challenges. The evolution of advanced airway modalities such as video laryngoscopes (VLs) and fiber-optic bronchoscopes had a major impact on the practice of anesthesia and the management of difficult airway scenarios in children and neonates. This article focuses on airway assessment and various current techniques and equipment used in airway management of cleft anomalies. Pediatric airway devices such as supraglottic airways, VLs, and fiber-optic bronchoscopes are briefly discussed with the benefits and limitations of each device. Recent studies describe specific problems as well as advantages with the usage of these devices.

Airway management of COVID-19 patients: A survey on the experience of 1125 physicians in Spain.

BackgroundWe explored the experience of clinicians from the Spanish Society of Anesthesiology (SEDAR) in airway management of COVID-19 patients.MethodsAn software-based survey including a 32-item questionnaire was conducted from April 18 to May 17, 2020. Participants who have been involved in tracheal intubations in patients with suspected or confirmed COVID-19 infection were included anonymously after obtaining their informed consent. The primary outcome was the preferred airway device for tracheal intubation. Secondary outcomes included the variations in clinical practice including the preferred video laryngoscope, plans for difficult airway management, and personal protective equipment.Results1125 physicians completed the questionnaire with a response rate of 40,9%. Most participants worked in public hospitals and were anesthesiologists.The preferred device for intubation was the video laryngoscope (5.1/6), with the type of device in decreasing order as follows: Glidescope, C-MAC, Airtraq, McGrath and King Vision. The most frequently used device for intubation was the video laryngoscope (70,5%), using them in descending order as follow: the Airtraq, C-MAC, Glidescope, McGrath and King Vision.Discomfort of intubating wearing personal protective equipment and the frequency of breaching a security step was statistically significant, increasing the risk of cross infection between patients and healthcare workers. The opinion of senior doctors differed from younger physicians in the type of video-laryngoscope used, the number of experts involved in tracheal intubation and the reason that caused more stress during the airway management.ConclusionsMost physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.

Anaesthetic Management of a Patient with Advanced Abdominal Pregnancy, Intrauterine Foetal Death and Celiac Disease

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation of fertilised ovum occurs in the abdominal cavity. If diagnosed late maternal and foetal mortality is very high. The major cause of death in abdominal pregnancy is haemorrhage. The case report is about a 31-year-old gravida two with 36 weeks of gestation period with Intrauterine Foetal Death (IUFD) and celiac disease. Celiac disease is a chronic malabsorptive disease of the small intestine occurring due to hypersensitivity to gluten ingestion. Due to chronic malabsorption, the patient presented with calcium deficiency. She also had lesions of dermatitis herpetiformis over the whole body sparing only the face. It is a rare case of advanced abdominal pregnancy with the IUFD, with celiac disease. The patient was managed successfully under general anaesthesia with preparedness for difficult airway management, securing wide bore peripheral cannulas, central venous cannulation and invasive blood pressure monitoring. Massive haemorrhage intraoperatively was managed with crystalloids, colloids, blood products and tranexamic acid. The intraoperative period was uneventful. The patient was extubated at the end of the surgery, and followed-up in a high dependency unit.

Efficiency of laryngeal mask airway ProtectorTM and i-gel® as a conduit in Aintree catheter-guided fibreoptic tracheal intubation: a randomised clinical trial.

Fibreoptic intubation through a supraglottic airway device (SAD) is recom-mended in difficult airway management algorithms. The Difficult Airway Society published a guideline describing the details of this technique in 2011. This study was designed to compare the efficiency of two different 2nd generation SADs as a conduit for Aintree catheter-guided fibreoptic tracheal intubation. 80 adult patients with an ASA score of 1-3 undergoing elective surgical procedures were included in the study. The patients were intubated after randomization to two groups: the i-gel group and the laryngeal mask airway (LMA) Protector group. SAD insertion time and tracheal intubation time were recorded separately. Demographic data, changes in haemodynamic parameters during the procedure, and complications were noted. In the LMA Protector and i-gel groups, the number of attempts (1.14 ± 0.35 vs. 1.24 ± 0.49 times, P = 0.394), device insertion time (14.89 ± 8.11 vs. 17.84 ± 16.59 seconds, P = 0.896), and the need for an optimization manoeuvre (43.2% vs. 37.8%, P = 0.813) were similar (P > 0.05). The fibreoptic laryngeal appearance scale and haemodynamic parameters were similar (P > 0.05). However, the airway complication rate was significantly higher in the LMA Protector group than in the i-gel group (21.6% vs. 2.7%, P = 0.013). The most common complications were bronchospasm and bloody secretion on SAD. With the stable haemodynamic parameters, acceptable insertion time and lower complication rate, we concluded that the i-gel may be preferable in fibre-optic tracheal intubation. The rigid structure of the LMA Protector compared to the i-gel might contribute to this result.

Ultrasonography Predicts Difficult Airway Management: A Prospective Double Blinded Study

Ultrasonography Predicts Difficult Airway Management: A Prospective Double Blinded Study

Correlation between predictors of difficult mask ventilation and its grading using a risk score

Background: Maintenance of airway patency and oxygenation are the main objectives of face mask ventilation. Preoperative prediction can reduce the incidence of unanticipated difficult mask ventilation (DMV). Aim of Study: The aim of this study was to evaluate the correlation between predictors of DMV and its grading using a risk score. Study Setting and Design: This was an observational study approved by the Institutional Ethics Committee in a tertiary care hospital between 2020 and 2021. Patients and Methods: A total of 110 adult patients scheduled for elective surgery under general anaesthesia were studied. A detailed preoperative airway assessment was done to identify and risk score for seven standard predictors of DMV (male gender, age >55 years, body mass index ≥30 kg/m2, obstructive sleep apnoea [STOP-BANG score], edentulous state, modified Mallampati class and presence of beard). The risk score was correlated with the grading of mask ventilation in the operation theatre performed using the four-point scale as described by Han et al. Results: A statistically significant association was found with standard predictors such as male gender, obstructive sleep apnoea (STOP-BANG score) and the total preoperative risk score with the grading of mask ventilation (P < 0.05 for all). Additional risk factors found statistically significant were interincisor distance, thyromental distance, neck circumference, receding mandible, mandibular jaw protrusion, restricted neck movements, buck teeth and submucosal fibrosis. Conclusion: Prediction of DMV with preoperative risk score can lead to better anticipation of difficult airway management. Appropriate anticipatory airway management could potentially decrease the incidence of failed ventilation and resultant hypoxia.

Massive Upper Gastrointestinal Bleeding.

This case is targeted to emergency medicine residents of all levels. Upper gastrointestinal bleeding (UGIB) is a common chief complaint encountered in the emergency department, resulting in over 500,000 hospitalizations and 20,000 deaths annually in the United States.1 The diagnosis and management of UGIB in stable patients is typically fairly straightforward. However, there are a number of circumstances where the treatment of UGIB is much more challenging, and emergency medicine (EM) physicians should be familiar with, and have experience managing, these difficult presentations. Massive UGIB can necessitate the need for management of a difficult airway in the setting of airway contamination, as well as placement of a gastroesophageal balloon tamponade device. The appropriate use and indications for performing this high-risk/low-frequency procedure requires dedicated practice. Furthermore, the management of gastrointestinal hemorrhage in a patient with a religious objection to the administration of blood products, including Jehovah's Witnesses, can be especially challenging and requires knowledge of alternative therapies to support blood pressure, oxygen carrying capacity, and decrease coagulopathy.2,3. By the end of this simulation, learners will be able to: 1) manage a hypotensive patient with syncope and hematemesis, 2) pharmacologically manage an acute UGIB addressing the various causes, 3) recognize worsening clinical status and intervene by performing difficult airway management, 4) place a gastroesophageal balloon tamponade device. This simulation was conducted with a high-fidelity mannequin with a separate medium-fidelity intubating mannequin that was modified to allow rapid filling of the oropharynx with simulated blood. Due to the COVID-19 pandemic, a total of six EM residents in various levels of training participated in the simulated patient encounter while the rest of the learners watched the simulation and participated in the debrief via video conference. Following the simulation and debrief session, all the residents, including those who participated in-person and via video conference, were sent a survey via surveymonkey.com to assess the educational quality of the simulation. Overall residents expressed positive feedback on the scenario, noting that the case was realistic, appropriately complex, and improved their medical knowledge and procedural skills. This case has a mixture of high-fidelity and medium-fidelity components which can be easily reproduced. The case was extremely useful in teaching EM residents of all levels not only how to manage large volume UGIB in a patient who is also a Jehovah's Witness, but also how to manage the airway and place a gastroesophageal balloon tamponade device. The case starts with a patient presenting with syncope and as the case unfolds, the patient's clinical status deteriorates, requiring learners to resuscitate, intubate, and obtain a gastroesophageal balloon tamponade.Residents commented that managing this case of an UGIB was extremely challenging because it exposed and filled important gaps in both their knowledge and procedural skills. Residents struggled most with identifying alternative therapies to blood products in patients with religious objections, and the step-by-step process of placing a Blakemore tube. Upper gastrointestinal bleed, hemorrhagic shock, Jehovah's Witness, difficult airway.

Perioperative anesthetic challenges in Alkaptonuria patient with comorbid conditions

Dear Editor, Alkaptonuria (AKU) is a rare autosomal-recessive inborn error of tyrosine metabolism which is a progressive debilitating disease and symptomatic around 30 years of age. In AKU, patient lacks enzyme required to breakdown homogentisic acid and on exposure to air complains of “black nappies.” Deposition of the onchronosis pigment in the large joints and spine causes joint destruction. In addition, there is involvement of airway, respiratory, renal, cardiac and coagulation system.[1] A 56-year-old man with AKU, G6PD deficiency, hypothyroidism, and hypertension, was scheduled for unilateral total knee arthroplasty. He was receiving levo-thyroxine 50 μg and amlodipine 5 μg once a day (OD). Over a span of 13 years the patient underwent multiple surgeries including lumbar thoracic, cervical fixation and, open cholecystectomy under general anesthesia. Neurological examination revealed hyperreflexia and spasticity in the lower limbs with decreased sensation over S1 dermatome. Airway examination revealed mouth opening of 5 cm, thyromental distance of 5.5 cm, limited neck extension (<10°), and a Mallampati class IV. Rest all investigations were normal. Patient was kept nil per oral prior to surgery and amlodipine and levo-thyroxine on the day of surgery. In the operating theatre, an 18 G intravenous line was secured, mandatory monitoring was attached and a difficult airway cart was kept ready. Patient was asked to self-position on the operation table. Following pre-oxygenation, IV fentanyl 2 μg/kg and propofol 2 mg/kg were administered. After loss of eyelash reflex, a check laryngoscopy was done with video-laryngoscope C-MAC® (Karl Storz, Germany) using a D-Blade which revealed a POGO of 75% with a granular deposit over the left posterior arytenoid, which adequate glottic chink. Vecuronium bromide 0.1 mg/kg was administered and trachea was intubated with 8.5 mm ID. Anesthesia was maintained with nitrous in oxygen, propofol infusion at 50-100 μg/kg/min, and intermittent boluses of vecuronium. At the end of surgery, an ultrasound-guided continuous femoral nerve block with 0.2% ropivacaine 15 ml bolus was performed followed by infusion of ropivacaine 0.2% with fentanyl 2 μg/ml. The surgery lasted for 2 h and vitals were stable during the entire period. 1.5 L of crystalloids were infused. Muscle paralysis was reversed. Black discolouration of heat and moisture exchanger as seen in this patient [Figure 1]. Trachea was extubated and the patient had an uneventful postoperative period.Figure 1: Black discolouration of heat and moisture exchanger in this patientCaring for a patient with AKU ochronosis with multiple comorbidities is challenging. Deposition of HGA in the cartilage of the airway and respiratory system can result in glottic stenosis leading to difficult airway management.[2] HGA deposits also make the dura and the arachnoid membrane vulnerable, therefore central neuraxial techniques were not preferred in the present case.[3] Drug-related precautions were observed for G6PD deficiency.[4] The learning points in this case is the preparedness for anticipated difficult airway, multimodal analgesia and good coordination with orthopedic team for perioperative management. Use of VL with shorter learning curve has changed the management in patients with difficult airway.[56] Since there is no approved treatment for AKU, with every repeated surgery these patients have progressively increasing anaesthetic challenges necessitating meticulous anesthetic management. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Emergency Cricothyrotomy - step by step

Emergency cricothyrotomy is a live saving intervention to rapidly gain access to the airways in patients who cannot be intubated nor ventilated. Considering complications such as bleeding, thyroid and cricoid cartilage injury and creation of a false tract emergency cricothyrotomy should not be performed until non-invasive attempts including video laryngoscopy and the use of supraglottic airway devices have been exploited within a fixed difficult airway management algorithm. Methods of emergency cricothyrotomy can be differentiated in a catheter-over-needle, Seldinger-wire and surgical technique. However, success is less dependent from the choice of method but from individual experience and training. Despite a lack of evidence due to its infrequent use cricothyrotomy generally results in an acceptable success rate. In this review a selection of commercially available cricothyrotomy sets is presented, indications for their use are outlined and their handling is described.

Comparative effectiveness of topical lignocaine nebulization and airway nerve blocks for awake fiber-optic nasal intubation in TM joint ankylosis

Background: Awake fiber-optic nasal intubation is a gold standard management of difficult airway in temporal mandibular (TM) joint ankylosis. Aims and Objectives: We compared topical lignocaine nebulization with airway nerve blocks for awake fiber-optic nasal intubation in TM joint ankylosis. Materials and Methods: Fifty patients of either gender were randomly allocated into two groups of 25 each. Group I received 10 ml of 2% lignocaine nebulization over a period for 20 min. Group II received bilateral superior laryngeal nerve block and transtracheal recurrent laryngeal nerve block (each with 2 ml of 2% lignocaine). Awake fiber-optic bronchoscopy-guided nasal intubation was done in all patients. All the patients received sedation during the procedure. The intubation time, intubating conditions, vocal cord position, cough severity, and degree of patient satisfaction were recorded. Student’s t-test was used to analyze parametric data, while the Mann–Whitney U-test was applied to non-parametric data and Fisher’s test to categorical data. P&lt;0.05 was considered statistically significant. Results: The time taken for intubation was significantly shorter in Group II [110.2 (14.6) s compared with Group I (211.0 [22.3] s) (P=0.028 ss). The intubating conditions and degree of patient comfort were better in Group II compared with Group I. Although all patients were successfully intubated, patient satisfaction was higher in Group II. Conclusion: Airway nerve block is a better way of anesthetizing airway as compared to nebulization for awake fiber-optic nasal intubation. However, nebulization with lignocaine may be an alternative in situations where nerve blocks are not feasible or may be used as an adjuvant to nerve blocks.

How to predict a difficult airway

According to The American Society of Anaesthesiologists Task Force, a difficult airway is defined as a clinical situation in which a conventionally– trained anaesthesiologist experiences difficulty with face mask ventilation and/or difficulty with tracheal intubation. Failing at efficient airway management is a source of major apprehension for physicians. Predicting difficult airway management is a mandatory part of clinical practice for paediatric and adult patients so as to avoid unexpected difficult airway management and adverse outcomes. Predicting a difficult airway is based on a focused medical history, review of prior medical records, physical examination, and specific tests for airway assessment. Each feature or airway test has its own sensitivity and specificity for the prediction of a difficult airway. All airway assessment tests are characterised by low sensitivity, reasonable specificity, and a low positive predictive value. Several scoring system models have been developed by multivariate analysis with multiple different integrated tests or risk factors to improve the prediction of a difficult airway, but with considerably different effectiveness to predict a difficult airway. According to the European Society of Anaesthesiology, systematic multimodal screening before airway management should include the Mallampati classification and thyromental distance, mouth opening or interincisor distance, range of motion of head and neck, compliance of the mandibular space, and the upper lip bite test.

A Retrospective Cohort Study of Acute Epiglottitis in Adults.

IntroductionAdult epiglottitis is a disease process distinct from pediatric epiglottitis in microbiology, presentation, and clinical course. While traditionally considered more indolent and benign than in children, adult epiglottitis remains a cause of acute airway compromise with a mortality rate from 1–20%. Our objective was to characterize the disease course and evaluate the rate and type of airway management in this population at a tertiary, academic referral center.MethodsWe conducted a retrospective chart review of all adult patients (age ≥ 18) who were definitively diagnosed with infectious “epiglottitis,” “supraglottitis,” or “epiglottic abscess” by direct or indirect laryngoscopy during a nine-year period. Double data abstraction and a standardized data collection form were used to assess patient demographic characteristics, presenting features, and clinical course. The primary outcome was airway intervention by intubation, cricothyroidotomy, or tracheostomy, and the secondary outcome was mortality related to the disease.ResultsSeventy patients met inclusion criteria. The mean age was 50.2 years (standard deviation ± 16.7), 60% of the patients were male, and 14.3% were diabetic. Fifty percent had symptoms that were present for ≥ 48 hours; 38.6% had voice changes, 13.1% had stridor, 12.9% had fever, 45.7% had odynophagia, and 47.1% had dysphagia noted in the ED. Twelve patients (17.1%) received an acute airway intervention including three who underwent emergent cricothyroidotomy, and one who had a tracheostomy. Two patients died and one suffered anoxic brain injury related to complications following difficult airway management.ConclusionIn this case series the majority of patients (82.9%) did not require airway intervention, but a third of those requiring intervention (5.7% of total) had a surgical airway performed with two deaths and one anoxic brain injury. Clinicians must remain vigilant to identify signs of impending airway compromise in acute adult epiglottitis and be familiar with difficult and failed airway algorithms to prevent morbidity and mortality in these patients.

Current practice of thoracic anaesthesia in Europe \u2013 a survey by the European Society of Anaesthesiology Part I \u2013 airway management and regional anaesthesia techniques

BackgroundThe scientific working group for “Anaesthesia in thoracic surgery” of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) has performed an online survey to assess the current standards of care and structural properties of anaesthesia workstations in thoracic surgery.MethodsAll members of the European Society of Anaesthesiology (ESA) were invited to participate in the study.ResultsThoracic anaesthesia was most commonly performed by specialists/board-certified anaesthetists and/or senior/attending physicians. Across Europe, the double lumen tube (DLT) was most commonly chosen as the primary device for lung separation (461/ 97.3%). Bronchial blockers were chosen less frequently (9/ 1.9%).Throughout Europe, bronchoscopy was not consistently used to confirm correct double lumen tube positioning. Respondents from Eastern Europe (32/ 57.1%) frequently stated that there were not enough bronchoscopes available for every intrathoracic operation. A specific algorithm for difficult airway management in thoracic anaesthesia was available to only 18.6% (n = 88) of the respondents. Thoracic epidural analgesia (TEA) is the most commonly used form of regional analgesia for thoracic surgery in Europe. Ultrasonography was widely available 93,8% (n = 412) throughout Europe and was predominantly used for central line placement and lung diagnostics.ConclusionsWhile certain „gold standards “are widely met, there are also aspects of care requiring substantial improvement in thoracic anaesthesia throughout Europe.Our data suggest that algorithms and standard operating procedures for difficult airway management in thoracic anaesthesia need to be established. A European recommendation for the basic requirements of an anaesthesia workstation for thoracic anaesthesia is expedient and desirable, to improve structural quality and patient safety.

Management of the Unexpected Difficult Airway in Neonatal Resuscitation.

A “difficult airway situation” arises whenever face mask ventilation, laryngoscopy, endotracheal intubation, or use of supraglottic device fail to secure ventilation. As bradycardia and cardiac arrest in the neonate are usually of respiratory origin, neonatal airway management remains a critical factor. Despite this, a well-defined in-house approach to the neonatal difficult airway is often lacking. While a recent guideline from the British Pediatric Society exists, and the Scottish NHS and Advanced Resuscitation of the Newborn Infant (ARNI) airway management algorithm was recently revised, there is no Norwegian national guideline for managing the unanticipated difficult airway in the delivery room (DR) and neonatal intensive care unit (NICU). Experience from anesthesiology is that a “difficult airway algorithm,” advance planning and routine practicing, prepares the resuscitation team to respond adequately to the technical and non-technical stress of a difficult airway situation. We learned from observing current approaches to advanced airway management in DR resuscitations in a university hospital and make recommendations on how the neonatal difficult airway may be managed through technical and non-technical approaches. Our recommendations mainly pertain to DR resuscitations but may be transferred to the NICU environment.

Manajemen Low Flow Anesthesia pada Pasien Kraniosinostosis dengan Hipertelorisme yang menjalani Four Box Wall Osteotomy, dan Eksisi Redundant Skin Fronto Nasal

Craniosynostosis is a case that diagnosed in the first year of life and can need surgical in young age. Craniosynostosis is a part of hypertelorism with incidence rate around 20%. Boy, 13 years old with hypertelorism had undergone multiple surgery for correction of hypertelorism before. Patient was planned to advance surgical correction of four box wall osteotomy which consist frontal part correction and part of it is release craniosynostosis in coronal suture. Risk of massive bleeding because patient already in teen age and length of surgery can be prolonged. Difficult airway management due to fascial deformity, use of low flow anesthesia to preserve temperature and reduce inhalation anesthesia usage, intraoperative fluid management in consideration maintenance and replacement blood loss and post operative pain management has become another consideration. Covid-19 as part of problems post operatively being known before extubation made the process is delayed. Massive bleeding needs massive transfusion protocol to speed up blood availability. Blood product such as PRC, FFP and TC should be available because coagulation factor is part of consideration. Anesthesia management in hypertelorism with four box wall osteotomy need good communication between anesthesiologist, neurosurgeon, plastic surgeon and pediatric intensivist to reduce perioperative risk including covid-19 in pandemic era.

Share the Airway: An Interdisciplinary Course for Management of the Unexpected Difficult Airway

IntroductionWithin the scope of practice of oral and maxillofacial surgery, the unexpected difficult airway may occur in the trauma bay, operating theater, postoperative, or office-based setting. Oral and maxillofacial surgeons must be trained to diagnose and intervene in anatomically or anesthetically compromised airways. An interdisciplinary training course hosted by an anesthesiology airway expert and oral and maxillofacial surgeon is a novel resident training opportunity. Materials and methodsIn August 2019 and October 2020, the department of anesthesiology and the division of oral and maxillofacial surgery at Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, co-hosted interdisciplinary educational sessions focused on management of the unexpected difficult airway, taught to residents and faculty. A SurveyMonkey (San Mateo, CA) questionnaire was taken 2 weeks before and after the course, with 10 questions assessing fund of knowledge in airway anatomy and physiology, etiology of difficult airway scenarios, difficult airway algorithm, and performance of emergency surgical airways. An interactive lecture on likely scenarios, airway algorithms, relevant surgical anatomy, routine and emergency airway management, airway devices, and emergency surgical airway techniques was conducted. A hands-on cricothyroidotomy tutorial using Crico-Trainer “Pig” (VBM, Sulz, DE) anatomic models with fresh porcine tracheas to simulate human airway anatomy were used. A post-course test consisted of a timed, filmed performance followed by a debriefing session. ResultsIncreased fund of knowledge and comfort with airway anatomy, difficult airway diagnosis and management, and emergency surgical airway techniques was evident between pre-and post-course surveys and was clearly demonstrated across multiple years. The sample size (n = 10, 2019; n = 7, 2020) was insufficient for statistical analysis. ConclusionInterdisciplinary didactic and clinical training in emergency airway management are of paramount importance to the oral and maxillofacial surgeon. Between years, a drop-off in knowledge base and technical skills occurred, even among senior staff, and all attendees agreed that periodic repetition is worthwhile. This course is now offered as part of the core curriculum on an annual basis and may be expanded to additional specialties for whom airway management is important.